Native arteriovenous fistulae are the best form of hemodialysis access. Every effort should be made to preserve and maintain these valuable access sites. The typical fistula is created from the distal radial artery to an adjacent forearm vein. Thrombosis is a relatively rare occurrence but when it occurs, surgical declotting is not as successful as percutaneous approaches. Thus, the interventional radiologist needs to be prepared to evaluate and declot fistulae. As the percentage of fistulae increases in the general dialysis population, radiologists expect to see the demand for percutaneous declotting increase. This article reviews approaches to declotting and maintaining fistulae. Common procedural complications and their treatment or follow-up are also reviewed.